- Humana (Providence, RI)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work… more
- Humana (Providence, RI)
- …a part of our caring community and help us put health first** The Manager, Utilization Management Behavioral Health utilizes behavioral health knowledge ... communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health works within specific… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Utilization Reviewer is responsible for facilitating care for members who may ... our Hingham, MA office. Hours of work: 8:30a - 4:30p EDT. The TeamThe Clinical Utilization Reviewer is part of a highly dedicated and motivated team of… more
- CenterWell (Providence, RI)
- …education spanning onboarding to continuing education. **Role Description** The LCSW Behavioral Health Educator will be embedded within the clinical education team ... and will oversee training aspects of the cognitive behavioral health screenings, psychosocial assessments, techniques that can be...has a deep understanding of all the High-risk program management roles and gains the respect and confidence of… more
- Humana (Providence, RI)
- …. At least five years of experience post-training providing clinical services . Experience in utilization management review and case management in a ... caring community and help us put health first** The Behavioral Health Medical Director responsible for behavioral ...work in their assigned cluster + Work includes computer-based review of moderately complex to complex clinical scenarios, … more
- Highmark Health (Providence, RI)
- …OVERVIEW: * Receive, review and make determinations regarding physician reviewer assignments for medical management decisions. Cases requiring physician ... agencies' standards including the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Committee (URAC), Pennsylvania Department of… more
- Highmark Health (Providence, RI)
- …Formularies, utilization management programs, and case/ disease management initiatives; providing clinical review and decisions for physician and ... utilization management programs, and disease management initiatives. + Provide clinical review and...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …care). + Experience as a working leader and managing member cases. + Utilization Management experience, preferred + Active licensure in Massachusetts is ... and regulatory standards to create, follow and appropriately document comprehensive care management plans. + Review medication list and educate members with… more
- Commonwealth Care Alliance (Boston, MA)
- …Community Health Workers (CHWs) are key supports to interdisciplinary care management teams and complement and support enrollees' needs, goals, and preferences. ... coaching skills to improve CCA enrollee outcomes by impacting care access and utilization , closing care quality gaps, and optimizing member connection to medical, … more
- Charter Care Health Partners (North Providence, RI)
- …acute behavioral health. Utilization review and inpatient behavioral health experience preferred. Computer database management experience and case ... other specialties on the unit. Performs functions related to Patient Advocacy; Utilization Review ; Resource Management ; Continuum of Care Management ,… more
- Highmark Health (Providence, RI)
- …**Job Description :** **JOB SUMMARY** This job captures all inbound inquires for utilization management review from providers and pharmacies. The incumbent ... the case (data entry) in Highmark's Utilization Management system for Prior Authorization clinical review ....job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Highmark Health (Providence, RI)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review , the incumbent participates as the...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
- OptiMindHealth (Boston, MA)
- …FLSA Status: Non-Exempt Location: Boston, MA Join a leading clinician-led behavioral health company today! OptiMindHealth (OMH) is expanding and seeking ... compassionate professionals to join our team. Today, OMH provides superior behavioral health services to patients in Massachusetts, Colorado, and Montana. Since… more
- Monte Nido (Dedham, MA)
- …regulatory agencies. + Conduct psychosocial assessments, participate in treatment planning, utilization review , and discharge planning. + Conduct individual, ... people to realize their healthy selves. **Adolescent Clinician** **Walden Behavioral Care** **Dedham- FT position** Walden Behavioral ...and ARFID cases. + Provide clinical care and case management in a manner consistent with the philosophy and… more
- CenterWell (Providence, RI)
- …by accessing and understanding formulary restrictions, plan limitations, drug utilization review overrides, requesting and completing prior authorization, ... good practices within the value-based model. + Know and continually review medication brand and generic names, medical terminology, and pharmaceutical calculations.… more
- The Home for Little Wanderers (Walpole, MA)
- …+ Assign cases to staff and monitor the caseload level. + Maintain the utilization review process. Ensure quality assurance standards are met with regard to ... youth who have experienced trauma and/or who have significant emotional and behavioral challenges. **How You'll Be Making A Difference** Provide clinical supervision… more
- Cecelia Health (Boston, MA)
- …the whole person with proactive, coordinated support focused on clinical, behavioral , social, and emotional needs across cardiometabolic and related conditions. ... customized analytics. The analytics support value-based care, population health management , quality outcomes, performance targets, and identification of potential… more
- The Home for Little Wanderers (Roslindale, MA)
- …reports) and billing in a timely manner. Ensure that documentation meets utilization review and quality assurance standards. + Attend in-service trainings ... neuropsychological, intellectual and emotional development, presence of learning disabilities, behavioral problems and need for psychopharmalogical intervention. Interpret results… more
- Sevita (Taunton, MA)
- …as requested + Organize and chair program participant conferences + Review the designated program participant's reports (evaluation, progress, and discharge) for ... clinical team meetings and regularly scheduled supervision meetings + Coordinate utilization with the Case Manager relative to program participant's incentive… more